This editorial is by Nora Saul, M.S., R.D., C.D.E., Manager of Nutritional Services at Joslin
There’s a commercial running whose announcer states that one of the best things about turning 65 is becoming eligible for Medicare; and if you have diabetes and need education, Medicare does give you a whole lot of bang for your buck.
From the Medicare administrators’ point of view, receiving education to help you control your diabetes is very important and worth spending money on. Diabetes and renal disease are the only two conditions that Medicare provides education benefits for.
Coverage for diabetes education, called diabetes self-management training (DSMT), is mandated by Medicare and it is quite a generous package. Since Medicare is a federal program, it doesn’t matter which of the 50 states you call home, the same education allowance applies.
In the first year you are referred, you are entitled to ten hours of education. This can be provided in half-hour or hour increments.
However, 9 of the 10 hours must be in a group setting unless there is an overriding reason you need an individual appointment. These would include being a non-native English speaker in a program that provides classes only in English, having a hearing or vision impairment or a significant mental or emotional disability.
Now many of you may be thinking, “I don’t feel comfortable discussing my medical issues in a group!” This can take a bit of getting used to, but after trying it many people realize its advantages.
There is even research defending the benefits of group learning. For one thing being in a room with people having the same disease makes you feel less alone. It also allows you to find out how others are handling the tasks of self-management, as well as providing a forum for questions.
In group sessions, you can get answers to questions you didn’t even know existed prior to coming. Finally, there is no requirement that you share information about yourself. If you prefer to sit back and absorb without participating that is always your choice.
Diabetes is a chronic disease and people need life-long education. Medicare recognizes that and provides another 2 hours each additional year. There is no stipulation for a group setting on subsequent year visits.
Now for some people, two hours a year isn’t enough. There may be special circumstances that demand the need for more education. So if there is a credible reason—you started on insulin after your completed your two visits, for example—your healthcare provider can write a secondary referral.
In addition, Medicare allows a separate benefit for medical nutrition therapy (MNT). You can receive basic education in nutrition therapy for diabetes in your self-management classes and you can get more in-depth individual counseling for nutritional issues. Medicare permits 3 hours in the first year and 2 additional hours for all subsequent years.
Keep in mind—MNT benefits are based on a calendar year. So if attend your first session on December 1st you only have until December 31 of that year to complete the first 3 hour allotment.
DSMT operates a bit differently. The first year is counted from the time you start your education. If you started in July you have until the following July to finish the 10 hours. Subsequent years the benefit begins to follow the calendar year just like MNT
Now to use either of these benefits, you will need a referral from your health care provider. In the case of the MNT benefit, the referral has to come from your physician specifically—a nurse practitioner or physician’s assistant doesn’t qualify. Referrals for DSMT can be completed by qualified non physician providers such as nurse practitioners or physician assistants.
And if patient patterns at Joslin are any indication for the rest of the country, many patients are using their complete benefit. No use letting good education dollars go to waste! Talk with your health care provider about getting a referral today.